Depression 14: Chronic Depression with Poor Coping Skills

Please be advised that this post discusses suicidal thoughts.

My second stay at the Crisis Stabilization Unit (CSU) ended mid-morning the day before my psychiatrist appointment. A kind friend gave me a ride home. Later, my mom came to see me and wanted to take me home to my parents’ place. I told her that the staff at the CSU encourage living in your usual circumstances before a psychiatrist appointment in order to get the best sense of how you’re doing leading up to your appointment. Wisely, she responded that she wanted me to be here (alive) to be able to go to my appointment the next day. Based on how I felt the last time I left the CSU, it was a good idea not to be alone that night. My mom drove me home and then back to the city the next day.

Most of my appointment involved talking to a psych nurse. For around an hour, I answered a lot of the same questions and described a lot of the same experiences as I had at the Crisis Response Centre (CRC) and the CSU. I talked about my cyclical experience of depressive symptoms over the past eight years; the increase in frequency of the symptoms over the last year; and the exhaustion, trouble falling asleep, and suicidal thoughts that had been steadily worsening over the last few months. I talked about both my healthy and unhealthy coping strategies and the supports and resources I had available. The nurse was pretty easy to talk to other than a couple times when she asked me to clarify something in a way that made me feel self-conscious about the experiences I was trying to describe.

After our discussion, the nurse left the room to talk to the psychiatrist. They talked for five minutes at the most. Then the psychiatrist came in and gave me a diagnosis of “chronic depression with poor coping skills.” I wasn’t expecting to hear the second part, and I found it upsetting. I started to cry.

The psychiatrist asked if I thought that didn’t sound right. I often need quite a bit of time to process my feelings and thoughts and to figure out how to explain them, but thankfully, this time I knew what to say. I’m glad I was able to voice my thoughts to the psychiatrist and proud of myself for doing so. I told her that, no, I didn’t think that sounded right. I told her that I had been doing a lot of good things for my health- eating well, exercising every day, getting enough sleep (until I started having trouble sleeping), staying connected to my church and friends, going to counselling- and if anything, doing all those good things was what had allowed me to stay functioning and working for as long as I had. Without acknowledging any of this, she responded by asking if I thought suicidal thinking was a good coping method. I said no, but by this point in my struggle, it actually felt like that was an appropriate response to the situation.

The psychiatrist gave me a doctor’s note for a couple more days until I had another appointment with my doctor. She didn’t think I needed to see a psychiatrist again, so she was leaving it up to my doctor to write any more notes for time off work. She raised my dose of citalopram, which is an antidepressant I had started taking a month earlier. She also referred me to a Cognitive Behavioural Therapy program. Those things were helpful. Walking in after talking to the nurse for three whole minutes and telling me I had poor coping skills, as part of the diagnosis and in the uncaring manner she did, was not! My fear of my struggles being my fault because of a millennial lack of basic living ability seemed to have been confirmed. I felt embarrassed and ashamed. I left the “poor coping skills” out when I told my mom about the appointment. The first person I told was my sister-in-law, and I think it took me at least a few weeks to tell her. She was the only person I told for quite a while.

Thankfully, in the weeks before my appointment, I had also been taking in other messages that allowed me to have more understanding for myself. I saw all the positive things I had been doing to try to manage my health. Through things like Kurt’s lecture, I saw that people I respect and admire also struggle with depression. My priest and a friend with knowledge about mental illness were especially understanding and said things that validated my pain as well as things that pointed to hope and my value in the world.

These messages allowed me to resist getting stuck on “poor coping skills” and thinking there were no contributing factors to my struggles besides being a stupid idiot. Sure, working on my coping strategies would be helpful, but I wasn't completely lacking coping skills and there was more going on than that. I guess that psychiatrist takes a straightforward approach, but as a client who was deeply hurting and who had indeed been working hard to cope, including some empathy or encouragement would have been more helpful.

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Suicide is terrible and tragic. It can be hard to talk about. It can be frightening to hear about. I am not encouraging suicidal ideation as a solution or trying to shock and harm with my words. I am sharing a part of my story, showing what depression can be like. This is one very real and serious part of my story that should not be left out. Talking about suicide can be difficult, but talking about these thoughts instead of hiding them can save lives. I am not the only person struggling with a mental illness who has been in this place. Thankfully, I also have other parts of my story that include difficult and ongoing healing. These parts of my story will come later.

Manitoba Suicide Prevention & Support Line (24/7): 1-877-435-7170
Klinic Crisis Line (24/7): 1-888-322-3019
You do not have to be in immediate crisis to call these lines.

Kristen